Current Charts Research Articles

Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort

ObjectivesConstruct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA:...

The efficacy of the current adult observation chart: audit of compliance with trust guidelines at City Hospital, Birmingham, UK

Background The Royal College Of Physicians (RCP) has shown that the multiplicity of locally developed Early Warning Scores (EWS) used throughout the UK is causing a ‘lack of consistency in detecting the deterioration of patients [1]. The RCP therefore produced a report in July 2012 proposing a National Early Warning Score (NEWS), a point based system, with the aim of standardisation across the UK. However, there is concern that if locally developed systems are working well why “fix what isn’t broken”. The current system used at Sandwell & West Birmingham Hospitals (SWBH) NHS Trust, UK is a simple colour coded observation chart. As observations become more abnormal they are documented in amber or red zones on the chart. Instructions on the chart explain that single “amber”, double “amber” or “red” observation should trigger a specified action, to be documented in the clinical notes, and increased frequency of observations. Previous audits of patients admitted to the Intensive Care Units of SWBH indicated that even this simple colour coded system was not accurately followed and could indicate that the NEWS, a more complicated point based system, may worsen compliance. The aims of this audit were to evaluate adherence to the current colour-coded EWS adult observation chart across a variety of wards.

A Carnian40Ar/39Ar age for the Paasselkä impact structure (SEFinland)—An update

AbstractA recrystallized band of pale feldspathic impact melt in a gneissic impact breccia from the approximately 10 km Paasselkä impact structure in southeast Finland was dated via40Ar/39Ar step‐heating. The newly obtained plateau age of 228.7 ± 1.8 (2.2) Ma (2σ) (MSWD = 0.32;p = 0.93) is equal to the previously published pseudoplateau age of 228.7 ± 3.0 (3.4) (2σ) for the impact event. According to the current international chronostratigraphic chart and using the most recent published suggestions for the K decay constants, a Carnian (Late Triassic) age for the Paasselkä impact structure of 231.0 ± 1.8 (2.2) Ma (2σ) is calculated and considered the most precise and accurate age for this impact structure. The new plateau age for Paasselkä confirms the previous dating result but is, based on its internal statistics, much more compelling.

AUDIT AND RE-AUDITS OF MEDICINE ADMINISTRATION RECORDS ON PAEDIATRIC INPATIENT PRESCRIPTION CHARTS—MISSED DOSE OR MEMORY LOSS

AimTo demonstrate that administration of medicines, or omissions, are recorded clearly and accurately on paediatric inpatient prescription charts, in accordance with the Trust medicines management policy. To provide evidence to...

Height of South Asian children in the Netherlands aged 0–20 years: secular trends and comparisons with current Asian Indian, Dutch and WHO references

Background: People from Asian populations are generally shorter than other ethnic groups. It is unknown if current universal height references are suitable for affluent South Asian children in the Netherlands.Aims: To develop height-for-age charts for contemporary South Asian children aged 0–20 years living in the Netherlands, to evaluate secular trends, and to compare the charts with current Asian Indian, Dutch and WHO references.Subjects and methods: A population-based study measured 3315 South Asian children aged 0–20 years between 2007–2010. Among this cohort, 6876 measurements were taken. Another 7388 measurements were taken of a historical cohort of 1078 children born between 1974–1976 (aged 0–18 years).Results: An upward trend in height was observed for South Asian children living in the Netherlands between 1992–2010. The height-for-age charts of the South Asian historical cohort were similar to current Asian Indian charts. South Asian children in the Netherlands were shorter than their Dutch contemporaries at every age; and these differences increased further during adolescence. Compared to the WHO height-for-age references, there were considerable discrepancies in height, with curves intersecting twice.Conclusion: The discrepancies between the South Asian and Dutch and WHO height-for-age references indicate differences in growth patterns between the source populations.

Risk of violence of inpatients with severe mental illness – Do patients with schizophrenia pose harm to others?

Individuals suffering from schizophrenia are frequently considered to be dangerous. The current longitudinal chart review was carried out to investigate the diagnostic mix of patients who were admitted to the Department of Psychiatry and Psychotherapy at the Medical University Innsbruck due to risk of harm to others. The sample consisted of all adult inpatients admitted to psychiatric acute care units in the years 1992, 1997, 2002, and 2007. Data collection included diagnoses, criteria for risk of harm to others, and the use of mechanical restraint. Altogether, 7222 admissions were reviewed. Of these, 529 patients had to be admitted to a locked unit because of risk of harm to others. Among those mechanical restraint was more often used in patients with organic mental disorders, Cluster B personality disorders, and mania than in patients with schizophrenia. Patients suffering from schizophrenia with comorbid psychoactive substance use constitute a potentially harmful population and are therefore frequently admitted to locked units due to risk of harm to others. However, in the current study additional coercive measures were more commonly applied in patients suffering from personality disorders and organic mental disorders.

Comments on "Modified wind chill temperatures determined by a whole body thermoregulation model and human-based convective coefficients" by Ben Shabat, Shitzer and Fiala (2013) and "Facial convective heat exchange coefficients in cold and windy environments estimated from human experiments" by Ben Shabat and Shitzer (2012).

Ben Shabat et al. (Int J Biometeorol 56(4):639-51, 2013) present revised charts for wind chill equivalent temperatures (WCET) and facial skin temperatures (FST) that differ significantly from currently accepted charts. They credit these differences to their more sophisticated calculation model and to the human-based equation that it used for finding the convective heat transfer coefficient (Ben Shabat and Shitzer, Int J Biometeorol 56:639-651, 2012). Because a version of the simple model that was used to create the current charts accurately reproduces their results when it uses the human-based equation, the differences that they found must be entirely due to this equation. In deriving it, Ben Shabat and Shitzer assumed that all of the heat transfer from the surface of their cylindrical model was due to forced convection alone. Because several modes of heat transfer were occurring in the human experiments they were attempting to simulate, notably radiation, their coefficients are actually total external heat transfer coefficients, not purely convective ones, as the calculation models assume. Data from the one human experiment that used heat flux sensors supports this conclusion and exposes the hazard of using a numerical model with several adjustable parameters that cannot be measured. Because the human-based equation is faulty, the values in the proposed charts are not correct. The equation that Ben Shabat et al. (Int J Biometeorol 56(4):639-51, 2013) propose to calculate WCET should not be used.

VIOLENCE AND SCHIZOPHRENIA: RISK FACTORS AND MEDIATORS

Individuals suffering from schizophrenia are frequently considered to be dangerous. The current longitudinal chart review was carried out to investigate the diagnostic mix of patients who were admitted to the Department of Psychiatry and Psychotherapy at the Medical University Innsbruck due to risk of harm to others. The sample consisted of all adult inpatients admitted to psychiatric acute care units in the years 1992, 1997, 2002, and 2007. Data collection included diagnoses, criteria for risk of harm to others, and the use of mechanical restraint. Altogether, 7222 admissions were reviewed. Of these, 529 patients had to be admitted to a locked unit because of risk of harm to others. Among those mechanical restraint was more often used in patients with organic mental disorders, Cluster B personality disorders, and mania than in patients with schizophrenia. Patients suffering from schizophrenia with comorbid psychoactive substance use constitute a potentially harmful population and are therefore frequently admitted to locked units due to risk of harm to others. However, in the current study additional coercive measures were more commonly applied in patients suffering from personality disorders and organic mental disorders.

Near-Infrared Spectral Image Analysis of Pork Marbling Based on Gabor Filter and Wide Line Detector Techniques

Marbling is an important quality attribute of pork. Detection of pork marbling usually involves subjective scoring, which raises the efficiency costs to the processor. In this study, the ability to predict pork marbling using near-infrared (NIR) hyperspectral imaging (900-1700 nm) and the proper image processing techniques were studied. Near-infrared images were collected from pork after marbling evaluation according to current standard chart from the National Pork Producers Council. Image analysis techniques-Gabor filter, wide line detector, and spectral averaging-were applied to extract texture, line, and spectral features, respectively, from NIR images of pork. Samples were grouped into calibration and validation sets. Wavelength selection was performed on calibration set by stepwise regression procedure. Prediction models of pork marbling scores were built using multiple linear regressions based on derivatives of mean spectra and line features at key wavelengths. The results showed that the derivatives of both texture and spectral features produced good results, with correlation coefficients of validation of 0.90 and 0.86, respectively, using wavelengths of 961, 1186, and 1220 nm. The results revealed the great potential of the Gabor filter for analyzing NIR images of pork for the effective and efficient objective evaluation of pork marbling.

Response to the study by V. Kumaravel et al., titled "Are the current Indian growth charts really representative?".

Response to the study by V. Kumaravel et al., titled "Are the current Indian growth charts really representative?".

Are the current Indian growth charts really representative? Analysis of anthropometric assessment of school children in a South Indian district

Background:India currently is posed by the double threat of thinness and overweight/obesity among children. Different growth charts have taken different population and give different cut-off points to assess these conditions.Objective:The objective of this study is to assess the anthropometry of school children, 5-18 years of age and thereby estimate the prevalence of childhood thinness, overweight and obesity. To analyze how the study population compares with that of Agarwal's growth chart.Materials and Methods:The anthropometric measurements of all the students who were studying from 1st to 12th standards were taken from 27 randomly selected Government and private schools. Prevalence of thinness, overweight and obesity were assessed using two standards – Indian standard given by Agarwal and International Standards given by International Obesity Task Force (IOTF).Results:The prevalence of thinness, overweight and obesity among 18,001 students enrolled as per Indian standard were 12.2%, 9.5% and 3% and as per International standard were 15.3%, 8.1% and 2.6% respectively. The mean and the 95th percentile values of body mass index for both boys and girls at all ages in this study are falling short of Agarwal's and IOTF values. Using international cut-offs as well as Indian cut-offs given by Agarwal, underestimate the prevalence of obesity among boys and girls of all age groups.Conclusion:This study shows that under and over-nutrition among school children is in almost equal proportions. There is an underestimation of obesity among children whenever an Indian or an International growth chart is used. Thus, this study brings out the need for a really representative growth chart.

Designing new growth charts for low-birth weight babies: need of the hour in India.

Literature reveals theories explaining low birth weight (LBW) babies' unplanned catch-up growth is related to several non-communicable diseases (NCDs) in adult-life. Is the current growth chart as per World Health Organization child growth standards of healthy breast feed infants and young child is applicable for even LBW or small for gestational age babies? There are high chances that these LBW babies who are growing "in their centiles" will be diagnosed as mild or moderate protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. Besides they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to "crossing the percentile" in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. Thus, we may require revision to make a separate standardized growth chart for LBW babies indicating how they should grow.

Medication Errors: Medication Orders with Error-Prone Abbreviations

Introduction: Ambiguous abbreviations are one the most common and preventable causes of medication errors. Clinicians use many abbreviations as a timesaving convenience; however they can be prone to misinterpretation. Aim: The aim of this practice review evaluation is to identify the top six error-prone abbreviations at a local Hospital and compare those results to previous review conducted at the same facility to detect any improvement in practice. Method: Copies of inpatient medication charts were randomly selected from each ward over a one-week period. A sample size of 100 patients’ charts was included in the audit. Only regular orders on all current medication charts were included in the review (excluding ceased orders). The audit tool used is based on indicator 3.3, “Percentage of medication orders that include error-prone abbreviations” published by the New South Wales, Australia; Therapeutic Advisory Group. Findings: A total of 47 error-prone abbreviations were detected which equates to an overall incidence of 6% (n=784 medication orders) which is higher than the results of the audits of 2008 (5.1%) and 2012 (5.3%). The most common error-prone abbreviation were ‘mcg or ug’ (57.4%), ‘od or OD’ (23.4%) and ‘U or IU’ (19.1%). There were no ‘leading zeros’, ‘trailing zeros’ or ‘qd or QD’ abbreviation in the sample audited. Conclusion: The audit suggests that the possible reasons for the increase in use of unapproved abbreviations may include: 1) junior medical officers were not instructed to use the New South Wales, Australia, Therapeutic Advisory Group guidelines or 2) some medical staff are in the habit of using varying abbreviations due to their previous work experience and practice standards. If these doctors had never received timely or direct feedback on their prescribing practices then they may not be aware that they are utilising error-prone abbreviations.

The growth charts of Estonian schoolchildren. Comparative analysis

The current growth charts of Estonian children are based on the data collected in 1996. The aim of this article is to study whether children still correspond to these norms. For that purpose, an overview is given of the height, weight and body mass index of Estonian schoolchildren. These measurements have been collected mainly from 2006–2009. These data are compared with the results of 1996 by means of statistical tests. During the interim period, the development of Estonian schoolchildren has changed. Children are significantly taller (boys by 4.84 cm and girls by 3.86 cm on average) and heavier (boys by 5.90 kg and girls by 4.20 kg on average). The mean body mass index has also increased significantly (in boys by 1.30 units and in girls by 0.99 units on average). In conclusion, it can be said that schoolchildren do not correspond well to the current norms, and the growth charts need updating.

Clinical process analysis: Embedding performance improvement skills for measurable and sustainable change.

67 Background: The Clinical Process Analysis methodology, based on Time Driven Activity Based Costing (Kaplan), aligns data reporting with frontline processes to drive improvement in clinical quality and financial performance. After the completion of 6 ambulatory centers (with 6 in progress), the program evolved to include a Performance Improvement (PI) Phase. The goal: embed PI skills in all clinical operations; provide resources for PI project initiation, facilitation, and sustainability; and continue collaboration with MD Anderson Cancer Center process owners through measurable improvement in safety, timeliness, effectiveness, efficiency, equity and patient-centeredness. (IOM 2001). Methods: The center and the CPA Team utilize institutional dashboards and multiple data resources to establish the project scope. The scope is converted to a Blueprint which outlines a timeline of the project, a list of required resources, and center-specific data. The CPA Team interviews frontline staff, clinical leadership and financial teams to create a current state process flow chart. Opportunities for Improvement (OFI), operational and clinical variations, cycle times and other management reporting metrics are included on the charts, as well as patient experience audio, as gathered by an MD Anderson marketing team. OFIs are evaluated, categorized, and prioritized by clinical leadership, and the CPA Team works with the center’s designated PI team to develop and implement Quick Fixes, PDSA and more extensive projects. Results: In 6 completed ambulatory centers in FY13: 176 Opportunities for Improvement, $936,463 Savings. Summary reports provide direct labor costs and estimated times, per resource type, for center activities. Per MDs, managers, staff and financial experts, other uses for process flow charts include: tracking patient flow; resource utilization; customer satisfaction; patient education; and on-boarding staff. Conclusions: In FY14, the CPA Program will focus on patient access in 15 centers, gathering data to identify trends and common themes to implement Best Practices across the institution.

The Relationship Between Prosocial Music and Helping Behaviour and its Mediators: An Irish College Sample

Previous research based on the General Learning Model (GLM) found that exposure to prosocial music increased helping behaviour. The present research aimed to test the effects of prosocial music from current music charts and popular television series. An initial experiment determined the themes of four prosocial and four neutral songs; the second experiment then found that prosocial music significantly increased helping behavior, relative to neutral music. The findings indicated no statistical difference on affect or arousal between the samples exposed to either prosocial or neutral music. These results are consistent with previous research and indicate the importance of prosocial music in creating cooperative social scenarios. Suggestions for future research including the necessity for field and longitudinal studies were discussed.

A Descriptive Analysis of Patients Presenting to Psychosexual Clinic at a Tertiary Care Center

Background:Psychosexual problems are very common presentation, be it with psychiatric or physical illness but there are very few studies available on psychosexual disorders especially in the Indian context. Indian society is deeply ingrained in customs and several misconceptions, myths, prejudices, and social taboos are attached to sex which makes it further very difficult to tackle.Objectives:The aim of this current study was to descriptively analyze the nature of sexual disorders in a tertiary care center.Materials and Methods:The current retrospective chart review included 698 consecutive subjects seeking treatment for their psychosexual problems at the Sexual Clinic, Department of Psychiatry, Dr. Ram Manohar Hospital, New Delhi (between 2006 and 2010).Results:This study observed erectile dysfunction (ED) (29.5%), Premature ejaculation (PME) (24.6%), Dhat syndrome (DS) (18.1%), and ED with PME (17.5%) as the common sexual dysfunctions leading to treatment seeking. DS was the major complaint among younger and unmarried individuals. We observed more married individuals seeking treatment for sexual disorders.Conclusions:These findings provide important information on a relatively under-researched area.

New design chart for basic wind speeds in Brazil

The design charts for basic wind speeds currently in use in Brazil [1] were created in 1977, based on wind speed records from 1950 to 1974. The database covered up to 25 years of wind records obtained in 49 weather stations, totaling 919 stationyears of data. Since 1974, additional 37 years of wind records became available, but have not been incorporated in the design code. Hence, the updated wind charts proposed in this paper are long overdue. In this paper, 62 years of wind records in Brazil are gathered in order to construct updated and more reliable wind charts. The original data by Padaratz [2] are complemented by data from 104 airport weather stations, made available through the Wolfram Research Database [3]. In total, 4142 stationyears of data are used in the present study, hence providing much better cover in terms of space and time span. Maximum annual wind speeds for the individual stations are fitted to Gumbel distributions, from which basic wind speeds are evaluated (mean return period of 50 years). Basic wind speeds are used to build a non-linear regression model, using the p-value of the Anderson-Darling goodness-of-fit test as regression weight. This ensures that extreme value wind distributions for which a good fit is obtained are given more importance in the regression model, reducing the influence of spurious data. The regression model developed herein is used to plot a new design chart for basic wind speeds in Brazil. It is proposed that this new wind chart be incorporated in the Brazilian code for design of structures subject to wind [1]. In this regard, it is observed that basic wind speeds obtained herein are higher than the wind speeds of the current chart for significant parts of Brazil (notably the center, northeast and north), and are the same or smaller in some parts of the south and southeast. It is shown herein that the main differences between the current and the proposed charts are not due to different modeling assumptions, but are mainly due to the new data. The proposed chart is updated, and is more reliable than the chart currently in use, as it reflects 4142 stationyears of data, and covers up to 62 years of wind records.

Conceptual basis for prescriptive growth standards from conception to early childhood: present and future

Healthy growth in utero and after birth is fundamental for lifelong health and wellbeing. The World Health Organization (WHO) recently published standards for healthy growth from birth to 6 years of age; analogous standards for healthy fetal growth are not currently available. Current fetal growth charts in use are not true standards, since they are based on cross-sectional measurements of attained size under conditions that do not accurately reflect normal growth. In most cases, the pregnant populations and environments studied are far from ideal; thus the data are unlikely to reflect optimal fetal growth. A true standard should reflect how fetuses and newborns 'should' grow under ideal environmental conditions. The development of prescriptive intrauterine and newborn growth standards derived from the INTERGROWTH-21(st) Project provides the data that will allow us for the first time to establish what is 'normal' fetal growth. The INTERGROWTH-21(st) study centres provide the data set obtained under pre-established standardised criteria, and details of the methods used are also published. Multicentre study with sites in all major geographical regions of the world using a standard evaluation protocol. These standards will assess risk of abnormal size at birth and serve to evaluate potentially effective interventions to promote optimal growth beyond securing survival. The new normative standards have the potential to impact perinatal and neonatal survival and beyond, particularly in developing countries where fetal growth restriction is most prevalent. They will help us identify intrauterine growth restriction at earlier stages of development, when preventive or corrective strategies might be more effective than at present. These growth standards will take us one step closer to effective action in preventing and potentially reversing abnormal intrauterine growth. Achieving 'optimal' fetal growth requires that we act not only during pregnancy but that we optimize the maternal uterine environment from the time before conception, through embryonic development until fetal growth is complete. The remaining challenge is how 'early' will we be able to act, now that we can better monitor fetal growth.

Audit of the Trust's quality account antibiotic indicators for correct use in paediatrics

ObjectivesThe objectives of this audit were to assess compliance with the paediatric antibiotic guideline for empirical treatment of infections and documentation of an indication plus stop/review date on the drug...